F R E E A u g u s t 2 2 , 2 0 18 / V o l u m e X X X V I I I , N u m b e r 5 2 / O u r 4 6 t h Ye a r
Online @ ITH ACA .COM
New York State Voter Registration Form Register to vote With this form, you register to vote in elections in New York State. You can also use this form to: • change the name or address on your voter registration • become a member of a political party • change your party membership
Send or deliver this form
Verifying your identity
Fill out the form below and send it to your county’s address on the back of this form, or take this form to the office of your County Board of Elections.
We’ll try to check your identity before Election Day, through the DMV number (driver’s license number or non-driver ID number), or the last four digits of your social security number, which you’ll fill in below.
Mail or deliver this form at least 25 days before the election you want to vote in. Your county will notify you that you are registered to vote.
To register you must:
Questions?
• be a US citizen; • be 18 years old by the end of this year; • not be in prison or on parole for a felony conviction; • not claim the right to vote elsewhere.
Call your County Board of Elections listed on the back of this form or 1-800-FOR-VOTE (TDD/TTY Dial 711)
formulario en español, llame al 1-800-367-8683
If you do not have a DMV or social security number, you may use a valid photo ID, a current utility bill, bank statement, paycheck, government check or some other government document that shows your name and address. You may include a copy of one of those types of ID with this form— be sure to tape the sides of the form closed. If we are unable to verify your identity before Election Day, you will be asked for ID when you vote for the first time.
Find answers or tools on our website
www.elections.ny.gov
Información en español: si le interesa obtener este
中文資料:若您有興趣索取中文資料表格, 請電: 1-800-367-8683
한국어: 한국어 양식을 원하시면
1-800-367-8683 으로 전화 하십시오.
Qualifications 2
Yes
Are you a citizen of the U.S.?
Student Survival Guide 2018
যদি আপদি এই ফর্মটি বাংলাতে পপতে চাি োহতল 1-800-367-8683 িম্বতে পফাি করুি
It is a crime to procure a false registration or to furnish false information to the Board of Elections. 1
Clear Form
Please print in blue or black ink.
No
For board use only
If you answer No, you cannot register to vote. Will you be 18 years of age or older on or before election day?
Yes
No
If you answer No, you cannot register to vote unless you will be 18 by the end of the year. Last name
Suffix
First name
Middle Initial
Your name
3
More information
4
Birth date
/
Items 5, 6 & 7 are optional
6
Phone
–
/ –
5
Sex
7
M
F
Address (not P.O. box)
The address where you live
8
Apt. Number City/Town/Village New York State County
The address where you receive mail
Voting information that has changed Skip if this has not changed or you have not voted before
9
10
Students, The Ithaca Times has got your back! Inside, find mentoring opportunities (p.22), fun classes (p.23), a quick primer on being an Ithacan (p.16)
Zip code
Have you voted before?
Yes
No
11
What year?
Your name was 12
Your address was
and...
Your previous state or New York State County was
This handy New York State voter registration form.
New York State DMV number 13
For questions, please refer to Verifying your identity above.
Last four digits of your Social Security number
x x x – x x –
I do not have a New York State driver’s license or a Social Security number.
Political party You must make 1 selection Political party enrollment is optional but that, in order to vote in a primary election of a political party, a voter must enroll in that political party, unless state party rules allow otherwise.
P.O. Box City/Town/Village
Identification You must make 1 selection
Select your New York State County
Address or P.O. box
Skip if same as above
Voting history
Zip code
14
I wish to enroll in a political party
Affidavit: I swear or affirm that
Democratic party Republican party Conservative party Green party Working Families party Independence party Women’s Equality party Reform party Other
• I am a citizen of the United States. • I will have lived in the county, city or village for at least 30 days before the election. • I meet all requirements to register to vote in New York State. • This is my signature or mark in the box below. • The above information is true, I understand that if it is not true, I can be convicted and fined up to $5,000 and/or jailed for up to four years.
16
I do not wish to enroll in a political party No party
15
I need to apply for an Absentee ballot.
I would like to be an Election Day worker.
Date
Rev. 03/2017
Optional questions
Sign